Patient Information Resources

Alpine Physical Therapy
Three Locations
In North, South, and Downtown Missoula
Missoula, MT 59804
Ph: 406-251-2323
Fax: 406-251-2999

Child Orthopedics
Pain Management
Spine - Cervical
Spine - General
Spine - Lumbar
Spine - Thoracic

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I'll be honest with you: I'm fat, over forty, and recently diagnosed with something called DISH (in my neck). Hurts to swallow and sometimes I just can get a thing down. Not good because then I eat more milkshakes. What can you tell me about this problem and what is my prognosis?

Dysphagia (difficulty swallowing), odynophagia (painful swallowing), and airway obstruction can be caused by this problem you have known as Diffuse Idiopathic Skeletal Hyperostosis or DISH. Until now, it was believed that DISH was a rare cause of compression of the esophagus and trachea. But thanks to the efforts of researchers in the Netherlands, we have found out that this condition is on the rise around the world. The most common finding of Diffuse Idiopathic Skeletal Hyperostosis (DISH) is ligaments that turn into bone. It is also known as Forestier's disease, after the name of the physician who first recognized it. DISH more commonly affects older males. It is usually associated with stiffness and back pain, but often it causes no signs or symptoms. When the cervical spine (neck) is affected, other symptoms such as stiff neck with loss of motion, difficulty swallowing, painful swallowing, choking, and snoring may occur. It is most often confirmed by x-ray when there are at least four vertebral segments in a row ossified (hardened into bone). Other imaging tests used in the differential diagnosis include barium swallow radiography, CT scan, laryngoscopy, and MRI. It has been observed that adults who develop DISH are more likely to also have type 2 diabetes and be obese. Both of those conditions are abnormalities in metabolism. Since the formation of bone depends on growth factors such as insulin-like Growth Factor. With more and more people who are obese and developing diabetes, it's possible the numbers of individuals affected by DISH will also increase in the coming years. As difficult as it may be, weight loss becomes one aspect of treatment. Antiinflammatories to help reduce swelling combined with eating soft foods may help. A nutrition expert can help you find ways to manage with healthy choices to avoid further weight gain. Pain relievers such as Tylenol are recommended on an "as needed" basis. Surgery to remove some of the bone build-up may be recommended. The surgeon may have to remove hardened ligaments, discs, and tendons. If the situation gets worse, the surgeon may opt to put a tube in the airway to allow you to breathe. There is always the chance of postoperative complications so prognosis varies depending on what treatment is used and whether or not surgery is involved. Studies actually show fairly even outcomes between patients treated conservatively versus surgically. The more severe the symptoms, the more likely surgery will be required. Deaths have been reported associated with difficulty breathing but this is rare. Surgical resection (removal) of the bone does not prevent more bone spurs or bone growth so in that way the prognosis is "guarded." Some patients find that they do well with conservative care. But an episode of swallowing wrong, an upper respiratory infection, or even minor trauma to the neck can flare symptoms. Until the exact cause of this problem can be determined (and treatment to address that cause), it's simply a matter of symptom management.


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